The calcineurin inhibitor tacrolimus reduces proteinuria in membranous nephropathy accompanied by a decrease in angiopoietin-like-4

PLoS One. 2014 Aug 28;9(8):e106164. doi: 10.1371/journal.pone.0106164. eCollection 2014.

Abstract

Tacrolimus is an anticalcineurinic agent with potent immunosuppressive activity that has recently been shown to have the added benefit of reducing proteinuria in membranous nephropathy (MN) patients. However, its potential mechanisms remain unknown. To reveal the mechanism, rat cohorts were administered tacrolimus or vehicle from days 7 to 28 after the induction of passive Heymann nephritis (PHN). PHN induction resulted in heavy proteinuria and increased expression of desmin, a marker of injured podocytes. We also showed that the glomerular expression of angiopoietin-like-4 (Angptl4) was markedly upregulated in PHN rats and human MN followed by an increase in urine Angptl4 excretion. In addition, increased Angptl4 expression may be related to podocyte injury and proteinuria. Furthermore, upregulated Angptl4 expression primarily colocalized with podocytes rather than endothelial or mesangial cells, indicating that podocytes may be the source of Angptl4, which then gradually migrated to the glomerular basement membrane over time. However, tacrolimus treatment markedly reduced glomerular and urinary Angptl4, accompanied by a reduction in the established proteinuria and the promotion of podocyte repair. Additionally, glomerular immune deposits and circulating IgG levels induced by PHN clearly decreased following tacrolimus treatment. In conclusion, this is the first demonstration that the calcineurin inhibitor tacrolimus can reduce Angptl4 in podocytes accompanied by a decrease in established proteinuria and promotion of podocyte repair in MN.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Angiopoietin-Like Protein 4
  • Angiopoietins / metabolism*
  • Animals
  • Calcineurin Inhibitors / administration & dosage*
  • Calcineurin Inhibitors / pharmacology
  • Disease Models, Animal
  • Female
  • Glomerulonephritis, Membranous / drug therapy*
  • Glomerulonephritis, Membranous / metabolism
  • Glomerulonephritis, Membranous / pathology
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin G / drug effects
  • Male
  • Middle Aged
  • Podocytes / drug effects
  • Podocytes / metabolism*
  • Podocytes / pathology
  • Proteinuria / drug therapy*
  • Proteinuria / metabolism
  • Proteinuria / pathology
  • Rats
  • Tacrolimus / administration & dosage*
  • Tacrolimus / pharmacology
  • Up-Regulation
  • Young Adult

Substances

  • ANGPTL4 protein, human
  • ANGPTL4 protein, rat
  • Angiopoietin-Like Protein 4
  • Angiopoietins
  • Calcineurin Inhibitors
  • Immunoglobulin G
  • Tacrolimus

Grants and funding

This study was supported by research grants from the National Basic Research Program of China 973 Program (No. 2012CB517602), Research Fund for the Doctoral Program of Ministry of Education of China (20122307110018), the National Natural Science Foundation of China (No. 81370812), the National Basic Research Program of China 973 Program (No. 2012CB517803), and the Heilongjiang Scientific research fund for postgraduates (YJSCX2012-237HLJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.